Fig. 2

Sex hormones and cerebrovascular development may underlie sex differences in autism spectrum disorder in humans. A Autism spectrum disorder (ASD) is characterized by sex-specific prevalence and symptomatology. B Sex hormone dysregulation could contribute to it with reports of high prenatal testosterone exposure and decreased brain aromatase expression in individuals with ASD. C Patterns of regional cerebral blood flow (rCBF) in limbic brain regions are modulated by sex*diagnosis suggesting higher neurovascular coupling abnormalities in men with ASD, in line with the higher male-biased diagnosis ratio. D Sex differences in blood levels of VEGF and Dkk1 are present in individuals with ASD with higher peripheral VEGF levels in women. De novo mutations of CTNNB1 indicate a potential role for key vascular pathways (VEGF and Wnt/β-catenin) in ASD pathophysiology. Full arrows represent empirical findings and dotted lines highlight hypothetical associations. Sex-specific differences in cerebrovascular function and the dysregulation of key vascular pathways, such as VEGF and Wnt/β-catenin, may contribute to the sex-specific prevalence and symptomatology observed in ASD. This suggests that understanding the interplay between sex-related factors and cerebrovascular mechanisms could provide valuable insights into the underlying pathophysiology of ASD and its sex-specific variations